Provider Demographics
NPI:1366249997
Name:LARSEN, JACI LYN
Entity type:Individual
Prefix:
First Name:JACI
Middle Name:LYN
Last Name:LARSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 TIMCHICK PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-0002
Mailing Address - Country:US
Mailing Address - Phone:308-346-4211
Mailing Address - Fax:
Practice Address - Street 1:2519 TIMCHICK PL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-0002
Practice Address - Country:US
Practice Address - Phone:308-346-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant